That number surpasses the MU attestation rate – so far – for any other vendor, according to publically available CMS statistics. In 2013, 95.4 percent of athenahealth clients attested for Stage 1 meaningful use, compared to 59 percent nationally,

The company employs a combination of coaching, campaigning, shared risk guarantees and a little cajoling to get their clients to goal, officials say.

Focus is critical, said Todd Rothenhaus, MD, chief medical officer and senior vice president of network knowledge at athenahealth. Stage 2 was about patients embracing the portal, viewing their medical record. So that's exactly what athenahealth set out to help their clients achieve.

"We were really tentative at first," Rothenhaus said. "You know, we've always been a B-to-B company. Our clients are our doctors, but then we realized that if we were going to meet meaningful use we had to get a little more bold in our direct client outreach and really support our doctors."

The company's software made it possible to make the portal easier for patients to use, making it much more attractive for them to message their docs, according to Rothenhaus.

"We made a bunch of functionality changes inside the workflow to make sure that people all along the chain, from front desk to medical assistant to doctor were enrolling people in the portal, or espousing its values to the patients," he said.

"We made it almost impossible for somebody to not look at their medical record when they logged into the portal," he said. "And, then we did a lot of campaigning. We emailed, we secure-texted, we actually used outbound phone calls. We did a lot of campaigning on behalf of our clients to get the patients to participate."

The athenahealth team also was able to insert pieces of code to test new letters and new ways of reaching patients, and do so very rapidly.

"We wrote off 5,000 in a couple of hours and looked at the results, see what the responses were and then iterated to see what worked – whether that was for pieces of code or different messages for outreach – for reaching a patient," Rothenhaus said.

Based on its success with its Guarantee Program for meaningful use attestation and ICD-10 preparation, athenahealth is expanding it to include value-based reimbursement for the Physician Quality Reporting System, or PQRS, and Medicare Shared Savings Program, or MSSP.

Prompting the move, in part, was an announcement by the Department of Health and Human Services that it would transition 50 percent of fee-for-service Medicare payments to quality-based alternative payment models by the end of 2018, part of the industry’s overall payment transformation.

“We care if our clients succeed or fail at revenue-impacting programs," said Rothenhaus, "and through our guarantees we make ourselves accountable to maximize their success."

"We believe healthcare organizations that deliver quality care at lower cost will emerge as the most successful in this new era of payment reform," Rothenhaus said, "and that’s why we’re putting skin in the game yet again to ensure our clients lead in the PQRS and Medicare Shared Savings programs.”

PQRS and the value-based payment modifier use a combination of incentive and penalty payment adjustments for participating providers of the Medicare Part B program, and MSSP rewards accountable care organizations that lower their healthcare costs while meeting quality standards. Both require provider organizations to track and report on quality – and for ACOs cost – beginning in 2015 in order to get paid.

How much a client pays athenahealth for services will directly align with the level of success athenahealth helps them attain. For example, the company guarantees successful reporting of PQRS data and will pay the penalties if the client fails to adequately report and meet quality performance standards. With its new value-based Guarantee Program, athenahealth is tying clients’ results to the company’s own for both PQRS and MSSP.